Skill 15[1]..Assisting with Child during Lumbar Puncture.pdf

SKILL 15

Assisting with Child during Lumbar Puncture

EQUIPMENT

Spinal tap (lumbar puncture) tray:

Antiseptic solution

Sterile drape

3-way stopcock

Spinal fluid pressure manometer

Lumbar puncture needle (various sizes)

Fluid collection tubes (3 or 4)

Gloves, sterile (physician)

Gloves, nonsterile (nurse)

Local anesthetic

Band-Aid or 2

FIGURE 15 Side-lying position for lumbar

puncture.

GENERAL GUIDELINES FOR DIAGNOSTIC

TESTS

1. Explain procedure to child and family. Enhances cooper-

ation and participation and reduces anxiety and fear.

2. Obtain signed consent.

3. Gather equipment. Promotes organization and effi-

ciency.

4. If possible, have child void before procedure. Promotes

comfort and avoids interruption of procedure.

5. Wash hands. Reduces transmission of microorganisms.

b. Sitting position.

1. Older child.

a. Sit on table with elbows resting on knees and

back arched.

b. Place pillow in front of child and instruct child

to grab it.

2. Small infant. (Figure 16)

a. Hold in sitting position.

b. Flex thighs on abdomen and grab elbows and

knees with hands. Flexes spine at appropriate

angle.

PROCEDURE

1. Steps 1–5 of General Guidelines.

2. Place child in a knee-to-chest position, either recum-

bent or seated, with neck flexed toward knees. Provides

maximal separation of vertebral bodies and allows access

to spinal canal.

a. Recumbent position (lateral recumbent). (Figure 15)

1. Infant or young child.

a. Restrain by placing one arm under child’s

flexed knees and grasping child’s wrists.

Restrains both upper and lower extremities.

b. Place other arm posteriorly around child’s

neck and shoulders.

2. Older child.

a. Child may grasp knees with hands.

b. May place a pillow between the knees.

Prevents the upper leg from rolling forward.

c. Nurse helps hold arms and legs in flexed posi-

tion.

NOTE: It may require someone with strength to safely

restrain the child during the procedure.

FIGURE 16 Sitting position for lumbar

puncture.

continued

2 gauze

Adhesive bandage

Gauze sponges

SKILL 15

Assisting with Child during Lumbar Puncture

continued

NOTE: This position is possible only with a small

infant who is unable to struggle or with an older child

who will cooperate without restraint.

b. Bleeding or CSF leakage at puncture site every 4

hours for 24 hours or according to agency policy.

c. Severe headache. Leakage of CSF through puncture

hole in meninges causes the headache pain.

8. Keep child flat after procedure for 1–24 hours depend-

ing on agency policy. Reduces the risk of spinal

headache.

9. Encourage child to force fluid by mouth unless con-

traindicated. Replaces fluid lost during the procedure

and reduces chance of spinal headache.

3. Once child is positioned, the physician drapes the back,

identifies and cleanses the puncture area, infiltrates the

area around the puncture site with local anesthetic, and

carries out the procedure. Strict aseptic technique is

maintained throughout.

4. See Assisting with Collection of Specimens (Skill 16).

5. During the procedure remind the child not to cough

and to breathe slowly and deeply. Coughing or changes

in breathing increase cerebrospinal fluid (CSF) pressure

giving a false reading.

6. Monitor for complications throughout the procedure;

changes in level of consciousness (LOC); pupil size and

reactivity; respiratory status; vital signs (VS); numbness,

tingling, or pain radiating down the legs.

7. After the procedure, continue to observe/monitor the

above as well as:

a. VS, LOC, and motor activity every 15 minutes for 1

hour, then every 30 minutes for 1 hour or according

to agency policy.

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